Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for Q4103. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
- Full-schedule CSV export and state network lists
- Email alerts when a state changes its rates
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Publishing states
22
Median % of Medicare
10.5%
Rate range
$3.40 - $124.11
Q4103 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $120.78* | -- | -- | 2026 |
| California | $4.35 | 3.4% | -- | 2026 |
| Colorado | $15.09 | 11.9% | -- | 2026 |
| District of Columbia | $119.93 | 94.2% | Required | 2026 |
| Georgia | $10.68 | 8.4% | -- | 2026 |
| Idaho | $101.16 | 79.5% | Not required | 2026 |
| Illinois | $12.59 | 9.9% | -- | 2023 |
| Indiana | $50.55 | 39.7% | -- | 2026 |
| Kentucky | $124.11 | -- | -- | 2026 |
| Michigan | $81.15 | 63.8% | -- | 2026 |
| Missouri | $112.18 | -- | Not required | 2026 |
| Montana | $12.49 | 9.8% | -- | 2026 |
| Nebraska | $13.35 | 10.5% | -- | 2026 |
| New Hampshire | $3.40 | 2.7% | Not required | 2026 |
| New Mexico | $12.48 | 9.8% | -- | 2025 |
| Oregon | $103.91* | 81.7% | -- | 2026 |
| South Carolina | $83.49 | 65.6% | -- | 2026 |
| Texas | $12.13* | 9.5% | -- | 2026 |
| Utah | $66.23* | -- | Not required | 2026 |
| Virginia | $12.49 | 9.8% | -- | 2025 |
| Vermont | $11.87 | 9.3% | -- | 2026 |
| West Virginia | $80.76 | 63.5% | -- | 2026 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * are representative published variants or methodology-derived rates. "--" in the prior-auth column means the state publishes no PA flag.
Related state-specific services codes
- C1716 - Brachytherapy source, non-stranded, gold-198, per source
- C1717 - Brachytherapy source, non-stranded, high dose rate iridium-192, per source
- C1719 - Brachytherapy source, non-stranded, non-high dose rate iridium-192, per source
- C2616 - Brachytherapy source, non-stranded, yttrium-90, per source
- C2634 - Brachytherapy source, non-stranded, high activity, iodine-125, greater than 1.01 mci (nist), per source
- C2635 - Brachytherapy source, non-stranded, high activity, palladium-103, greater than 2.2 mci (nist), per source
- C2636 - Brachytherapy linear source, non-stranded, palladium-103, per 1 mm
- C2638 - Brachytherapy source, stranded, iodine-125, per source
All 325 codes from Q4001 to Q4420 or every state-specific services code by number.
Frequently asked questions
How much does Medicaid pay for Q4103?
22 state Medicaid programs publish a fee-for-service rate for Q4103 (oasis burn matrix, per square centimeter (add-on, list separately in addition to primary procedure)), ranging from $3.40 in New Hampshire to $124.11 in Kentucky, with a median of 10.5% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for Q4103?
Kentucky publishes the highest Medicaid rate for Q4103 at $124.11. New Hampshire publishes the lowest at $3.40.
Does Q4103 require prior authorization under Medicaid?
1 of the 22 publishing states flag Q4103 as requiring prior authorization (always or conditionally) on their fee schedules. States without a flag publish no PA indicator for this code - that means "not published", not "no PA required".